Health Information Management Coding and Revenue Analyst-Medical Records

Job Objective:

Ensures the accuracy, integrity, and compliance of coded health system encounters across inpatient and outpatient settings including outpatient surgery, emergency, and observation. Conducts retrospective audits, validates code assignment, validates charges where appropriate, and evaluates adequacy in alignment with organizational policies. Serves as an HIM Epic and 3M-360 Super-user.

Essential Responsibilities:

• Demonstrates compliance with Code of Conduct and compliance policies and takes action to resolve compliance questions or concerns and report suspected violations.
• Works closely with HIM Director and Managers to support revenue cycle initiatives, including denials and appeals.
• Performs routine and targeted audits of inpatient and outpatient (OPPS/APC), encounters; assist with work queue management and troubleshooting account routing issues. 
• Validates diagnosis, procedure or modifier assignment; confirms accurate DRG/APR-DRG/HCC/APC capture as applicable.
• Communicates with vendors on a daily basis, manages Epic work queues/DNFC, investigates and completes coding updates and corrections, coordinates appeals, denials, and rebills.   
• Reviews documentation for completeness, specificity, and consistency; identifies query opportunities and documentation gaps.
• Applies editing logic (NCCI, MUEs) and client/organizational standards to assess compliance.
• Supports denials management workflows, including work queue management, tracking and ensuring timeliness of appeal responses.  
• Supports 3M-360 initiatives, including reporting and analytics; supports system enhancements and upgrades in the testing and production environments. 
• Interacts with organizational leaders, medical staff, Clinical Documentation Improvement, Hospital and Clinic Billing offices and others needing HIM coding support.
• Supports HIM’s role in coordinating appeals, denials, payer and RAC audits, rebills, hospital-acquired conditions (HAC), including review and analysis of payer and regulatory communications, performing chart review and account analysis, and making appropriate recommendations; communicates with third-parties and payers regarding coding issues. 
• Supports California state reporting, including data validation, correction, and submission within regulatory requirements. 
• Coordinates onboarding and off-boarding of vendor staff.  
• Maintains current AHIMA credentials, certifications, and carries out work duties in accordance with the AHIMA Code of Ethics.
• Performs special projects and supports HIM and revenue cycle initiatives as needed. 
• Performs other duties as assigned.

Essential Skils:

• Ability to investigate and analyze multiple coding resources such as Coding Clinic, CPT Assistant, coding and charging for devices and implants, Local/National coverage determinations and payer contracts
• Ability to create and maintain positive interpersonal relations with peers, staff, leaders and vendors
• Extensive working knowledge of revenue cycle workflows, charging, revenue integrity, and hospital accounting principles
• Ability to adapt quickly to changing priorities and unexpected situations
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, charging, and billing
• Written and verbal communication skills
• Expert-level working knowledge of inpatient and outpatient coding guidelines, including ICD-10-CM/PCS and CPT
• Working knowledge of Epic workflows pertinent to HIM, coding, and revenue cycle
• Expert knowledge of 3M encoder and related products
• Proficient in using Microsoft Office applications with advanced working knowledge of Excel